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Oncology Nursing

Oncology Nursing. NEO 113 JuLy 16, 2011. Oncology defined. Branch of medicine that deals with the study, detection, treatment and management of cancer . “Root words”. Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location. “Root words”. A- none Ana- lack

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Oncology Nursing

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  1. Oncology Nursing NEO 113 JuLy 16, 2011

  2. Oncology defined • Branch of medicine that deals with the study, detection, treatment and management of cancer

  3. “Root words” • Neo- new • Plasia- growth • Plasm- substance • Trophy- size • +Oma- tumor • Statis- location

  4. “Root words” • A- none • Ana- lack • Hyper- excessive • Meta- change • Dys- bad, deranged

  5. CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS • Radiation • Exposure to irritants • Exposure to sunlight • Altitude, humidity

  6. CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS • Smoking • Dietary ingredients • Drugs

  7. CANCER NURSING Etiology of cancer • Genetics and Family History • Colon Cancer • Breast cancer

  8. CANCER NURSING Etiology of cancer • Dietary Habits • Low-Fiber • High-fat • Processed foods • alcohol

  9. CANCER NURSING Etiology of cancer • Viruses and Bacteria • DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus • RNA Viruses- HIV, HTCLV • Bacterium- H. pylori

  10. CANCER NURSING Etiology of cancer • Hormonal agents • DES • OCP especially estrogen

  11. CANCER NURSING Etiology of cancer • Immune Disease • AIDS

  12. CANCER NURSING Body Defenses Against TUMOR • 1. T cell System/ Cellular Immunity • Cytotoxic T cells kill tumor cells • 2. B cell System/ Humoral immunity • B cells can produce antibody • 3. Phagocytic cells • Macrophages can engulf cancer cell debris

  13. CANCER NURSING Cancer Diagnosis • 1. BIOPSY • The most definitive • 2. CT, MRI • 3. Tumor Markers

  14. CANCER NURSING Cancer Staging The degree of DIFFERENTIATION • Stage 1- Low grade • Stage 4- high grade

  15. CANCER NURSING GENERAL MEDICAL MANAGEMENT • 1. Surgery- cure, control, palliate • 2. Chemotherapy • 3. Radiation therapy • 4. Immunotherapy • 5. Bone Marrow Transplant

  16. CANCER NURSING GENERAL Pharmacology • 1. antimetabolites • 2. antibiotics • 3. plant alkaloids • 4. antiemetics

  17. CANCER NURSING GENERAL Promotive and Preventive Nursing Management • 1. Lifestyle Modification • 2. Nutritional management • 3. Screening • 4. Early detection

  18. SCREENING • 1. Male and female- Occult Blood, CXR, and DRE • 2. Female- SBE, CBE, Mammography and Pap’s Smear • 3. Male- DRE for prostate, Testicular self-exam

  19. Nursing Assessment Utilize the ACS 7 Warning Signals • CAUTION • C- Change in bowel/bladder habits • A- A sore that does not heal • U- Unusual bleeding • T- Thickening or lump in the breast • I- Indigestion • O- Obvious change in warts • N- Nagging cough and hoarseness

  20. Nursing Assessment • Weight loss • Frequent infection • Skin problems • Pain • Hair Loss • Fatigue • Disturbance in body image/ depression

  21. Nursing Intervention • MAINTAIN TISSUE INTEGRITY • Handle skin gently • Do NOT rub affected area • Lotion may be applied • Wash skin only with SOAP and Water

  22. Nursing Intervention • MANAGEMENT OF STOMATITIS • Use soft-bristled toothbrush • Oral rinses with saline gargles/ tap water • Avoid ALCOHOL-based rinses

  23. Nursing Intervention • MANAGEMENT OF ALOPECIAAlopecia begins within 2 weeks of therapy • Regrowth within 8 weeks of termination • Encourage to acquire wig before hair loss occurs • Encourage use of attractive scarves and hats • Provide information that hair loss is temporary BUT anticipate change in texture and color

  24. Nursing Intervention • PROMOTE NUTRITION • Serve food in ways to make it appealing • Consider patient’s preferences • Provide small frequent meals • Avoids giving fluids while eating • Oral hygiene PRIOR to mealtime • Vitamin supplements

  25. Nursing Intervention • RELIEVE PAIN • Mild pain- NSAIDSModerate pain- Weak opiods • Severe pain- Morphine • Administer analgesics round the clock with additional dose for breakthrough pain

  26. Nursing Intervention • DECREASE FATIGUE • Plan daily activities to allow alternating rest periods • Light exercise is encouraged • Small frequent meals

  27. Nursing Intervention • IMPROVE BODY IMAGE • Therapeutic communication is essential • Encourage independence in self-care and decision making • Offer cosmetic material like make-up and wigs

  28. Nursing Intervention • ASSIST IN THE GRIEVING PROCESS • Some cancers are curable • Grieving can be due to loss of health, income, sexuality, and body image • Answer and clarify information about cancer and treatment options • Identify resource people • Refer to support groups

  29. Nursing Intervention • MANAGE COMPLICATION: INFECTION • Fever is the most important sign (38.3) • Administer prescribed antibiotics X 2weeks • Maintain aseptic technique • Avoid exposure to crowds • Avoid giving fresh fruits and veggie • Handwashing • Avoid frequent invasive procedures

  30. Nursing Intervention • MANAGE COMPLICATION: Septic shock • Monitor VS, BP, temp • Administer IV antibiotics • Administer supplemental O2

  31. Nursing Intervention • MANAGE COMPLICATION: Bleeding • Thrombocytopenia (<100,000) is the most common cause • <20, 000 spontaneous bleeding • Use soft toothbrush • Use electric razor • Avoid frequent IM, IV, rectal and catheterization • Soft foods and stool softeners

  32. Colon cancer

  33. COLON CANCER • Risk factors • 1. Increasing age • 2. Family history • 3. Previous colon CA or polyps • 4. History of IBD • 5. High fat, High protein, LOW fiber • 6. Breast Ca and Genital Ca

  34. COLON CANCER • Sigmoid colon is the most common site • Predominantly adenocarcinoma • If early 90% survival • 34 % diagnosed early • 66% late diagnosis

  35. COLON CANCER • PATHOPHYSIOLOGY • Benign neoplasm DNA alteration malignant transformation malignant neoplasm  cancer growth and invasion  metastasis (liver)

  36. COLON CANCER • ASSESSMENT FINDINGS1. Change in bowel habits- Most common • 2. Blood in the stool • 3. Anemia • 4. Anorexia and weight loss • 5. Fatigue • 6. Rectal lesions- tenesmus, alternating D and C

  37. Colon cancer • Diagnostic findings • 1. Fecal occult blood • 2. Sigmoidoscopy and colonoscopy • 3. BIOPSY • 4. CEA- carcino-embryonic antigen

  38. Colon cancer • Complications of colorectal CA • 1. Obstruction • 2. Hemorrhage • 3. Peritonitis • 4. Sepsis

  39. Colon cancer • MEDICAL MANAGEMENT • 1. Chemotherapy- 5-FU • 2. Radiation therapy

  40. Colon cancer • SURGICAL MANAGEMENT • Surgery is the primary treatment • Based on location and tumor size • Resection, anastomosis, and colostomy (temporary or permanent)

  41. Colon cancer NURSING INTERVENTION Pre-Operative care • 1. Provide HIGH protein, HIGH calorie and LOW residue diet • 2.Provide information about post-op care and stoma care • 3. Administer antibiotics 1 day prior

  42. Colon cancer NURSING INTERVENTION Pre-Operative care • 4. Enema or colonic irrigation the evening and the morning of surgery • 5. NGT is inserted to prevent distention • 6. Monitor UO, F and E, Abdomen PE

  43. Colon cancer NURSING INTERVENTION Post-Operative care • 1. Monitor for complications • Leakage from the site, prolapse of stoma, skin irritation and pulmo complication • 2. Assess the abdomen for return of peristalsis

  44. Colon cancer NURSING INTERVENTION Post-Operative care • 3. Assess wound dressing for bleeding • 4. Assist patient in ambulation after 24H • 5.provide nutritional teaching • Limit foods that cause gas-formation and odor • Cabbage, beans, eggs, fish, peanuts • Low-fiber diet in the early stage of recovery

  45. Colon cancer NURSING INTERVENTION Post-Operative care • 6. Instruct to splint the incision and administer pain meds before exercise • 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage • 8. Manage post-operative complication

  46. Colon cancer • NURSING INTERVENTION: COLOSTOMY CARE • Colostomy begins to function 3-6 days after surgery • The drainage maybe soft/mushy or semi-solid depending on the site

  47. Colon cancer • NURSING INTERVENTION: COLOSTOMY CARE • BEST time to do skin care is after shower • Apply tape to the sides of the pouch before shower • Assume a sitting or standing position in changing the pouch

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